Provider Demographics
NPI:1891244406
Name:OPTUM PALLIATIVE AND HOSPICE CARE OF TEXAS, INC.
Entity Type:Organization
Organization Name:OPTUM PALLIATIVE AND HOSPICE CARE OF TEXAS, INC.
Other - Org Name:HOSPICE INSPIRIS OF TEXAS INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SR. VICE PRESIDENT/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:O
Authorized Official - Last Name:ENDERLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-221-0793
Mailing Address - Street 1:1009 WINDCROSS CT.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2678
Mailing Address - Country:US
Mailing Address - Phone:615-224-5443
Mailing Address - Fax:844-727-9218
Practice Address - Street 1:5859 FARINON DR
Practice Address - Street 2:SUITE 150
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-3460
Practice Address - Country:US
Practice Address - Phone:210-684-3900
Practice Address - Fax:844-727-9218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No207PH0002XAllopathic & Osteopathic PhysiciansEmergency MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX273741Medicare PIN
TX671571Medicare PIN
TX361970Medicare PIN